Raymond N. Divirgilio

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00031600 Issued in NJ

Practice address

1000 Morris Ave
Union, NJ 07083-7133

Phone

(908) 737-0663

NPI assigned

Jan 2, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1514851200000",
    "number": "1003323908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 GLENWOOD RD",
            "city": "FANWOOD",
            "state": "NJ",
            "postal_code": "070231474",
            "telephone_number": "908-737-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MORRIS AVE",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070837133",
            "telephone_number": "908-737-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVIRGILIO",
        "first_name": "RAYMOND",
        "middle_name": "N.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-02",
        "last_updated": "2018-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00031600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Union, NJ
• Providers in Union, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.